How to live successfully with heart failure

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Even the words themselves — heart failure — sound frightening and hopeless, as if the end is near and nothing can be done. But nothing could be further from the truth. Millions of Americans are learning that heart failure, while it's a progressive condition with no known cure, can be effectively managed for many years through a carefully balanced combination of food and fluid intake, prescribed medications, exercise and healthy lifestyle choices.

Affecting nearly five million people in the U.S. alone, heart failure occurs when heart muscles become damaged, either from a single event like a heart attack or more commonly through the long-term impact of high blood pressure, coronary artery disease, diabetes and other conditions. The weakened heart gradually loses its ability to pump enough blood to supply the body's needs. Fluid congestion builds and the resulting symptoms may include shortness of breath, even during mild activity; difficulty breathing when lying down; weight gain with swelling in the legs and ankles; and general fatigue. Many patients don't even know they have the condition because symptoms often are mistaken for signs of aging.

Managing heart failure is a team effort, and the patient is the most critical player. Your doctor or nurse practitioner will prescribe medications and oversee your care. Other team members, including RNs, dietitians, pharmacists, and nutrition and exercise specialists, will help you succeed. But ultimately, it is up to you to take your medications, make dietary changes, live a healthy lifestyle and be proactive in your self-care. With the right management, heart failure won't stop you from doing the things you enjoy.

The goals are to help you live longer, breathe more easily, have more energy, increase your activity, have less swelling and stay out of the hospital. The plan should include these elements:

Limiting and measuring your salt intake: Sodium causes your body to hold extra fluid, making it harder for your heart to pump. For most patients, a low-sodium diet of no more than 2,000 milligrams per day (less than one teaspoon) is the prescription. It's not just a casual matter of "watching your salt" and going easy with the shaker. You need to know exactly how much you're consuming, not only in your home-cooked meals, but in the packaged foods you buy. The simplest rule of thumb is to avoid processed foods altogether, as they invariably are loaded with salt. Focus on fresh, whether it's fruits, vegetables or meats. If you do buy packaged foods, read the labels closely.



Limiting and measuring your fluid intake:
Since excess fluid is the main concern with heart failure, it's important to manage your external fluid intake carefully. Your health care provider will tell you how much fluid you should consume each day. Usually, it will range from 4 to 8 cups or 48 to 64 ounces, depending on the severity of the condition. Anything that turns to fluid while consuming it, like ice cream and Jell-O, must be counted in the daily total.

Taking medications: Most people with heart failure require several medicines for the best results, including diuretics that reduce fluid retention. It is common for your provider to increase the dose of these medicines even if you feel better after starting them. The goal is not just to make you feel better in the short run, but to treat the underlying disease and improve your health long-term. Stick with your prescriptions.



Staying physically active:
Years ago, it was believed people with heart failure shouldn't exert themselves and strain the heart. We now know exercise is critical for heart failure patients, producing oxygen for energy and improved ability to perform daily activities. Your provider can connect you with programs to teach you how to exercise safely and effectively. It's also important to recognize the warning signs of fluid buildup, such as sudden weight gain. That's why heart failure patients are advised to weigh themselves daily and report any unexplained increase.

Alicia Emerson is a nurse practitioner specializing in heart failure management with Berkshire Health Systems.


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